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PriorityMedicare Thrive Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PriorityMedicare Thrive Plus (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PriorityMedicare Thrive Plus (PPO) in 2026, please refer to our full plan details page.
PriorityMedicare Thrive Plus (PPO) is a PPO plan offered by Corewell Health available for enrollment in 2025 to people living in 68 lower peninsula Michigan counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that PriorityMedicare Thrive Plus (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about PriorityMedicare Thrive Plus (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For PriorityMedicare Thrive Plus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $100.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $5600.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5600.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The PriorityMedicare Thrive Plus (PPO) plan features a low $100 annual drug deductible and offers affordable copays for generic medications. For Tier 1 preferred generics, you can pay as little as a $1 copay for a 1-month supply, or enjoy no copay for a 3-month supply at preferred pharmacies and preferred mail order. Tier 2 generic drugs cost as low as a $7 copay for a 1-month supply, with no copay for a 3-month supply when ordered through preferred mail delivery. Brand-name and specialty medications under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require 22% coinsurance at preferred pharmacies and 25% at standard pharmacies, while Tier 4 non-preferred drugs carry a 35% or 40% coinsurance. Specialty medications in Tier 5 require a 31% coinsurance for a 1-month supply at both preferred and standard pharmacies.
Additional Benefits
The PriorityMedicare Thrive Plus (PPO) plan offers comprehensive coverage with no copay and no coinsurance for primary care visits, telehealth, and many preventive services. Members also benefit from a generous dental allowance of up to $2,500 annually with no copay or coinsurance for most routine and restorative care, alongside covered routine hearing exams and a $100 eyewear allowance. Specialist visits are also highly affordable, ranging from no copay up to a $40 copay with no coinsurance. For more intensive medical needs, inpatient hospital stays require a $300 daily copay for the first seven days and no copay thereafter, while outpatient hospital services range from no copay to a $350 copay. Emergency room visits carry a $130 copay which is waived if admitted, and home health services are covered with no copay and no coinsurance. Additionally, durable medical equipment and dialysis services are covered with no copay and a standard 20% coinsurance.
Inpatient Hospital See details
PriorityMedicare Thrive Plus (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $300 daily copay for days 1 to 7 and no copay for day 8 and beyond, whereas psychiatric stays require a $290 daily copay for days 1 to 6 and no copay for days 7 to 90. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
PriorityMedicare Thrive Plus (PPO) covers outpatient hospital services with a $0 to $350 copay, ambulatory surgical center services with a $40 copay, and outpatient blood services with no copay, all with no coinsurance. Observation services incur a $130 copay per stay with no coinsurance, and while some outpatient substance abuse services are covered with no copay or coinsurance, individual and group sessions are not covered.
Partial Hospitalization See details
PriorityMedicare Thrive Plus (PPO) covers partial hospitalization services with a $55 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
PriorityMedicare Thrive Plus (PPO) covers ground and air ambulance services with a $240 copay and no coinsurance, subject to prior authorization. Although transportation services are listed as covered, only some services are covered in practice, as transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
PriorityMedicare Thrive Plus (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $130 for emergency care, $50 for urgent care, and $240 for emergency transportation.
Primary Care See details
PriorityMedicare Thrive Plus (PPO) features primary care, telehealth, and opioid treatment services with no copay and no coinsurance, alongside specialist visits with a $0 to $40 copay and no coinsurance. Physical, occupational, speech, and routine chiropractic therapies have a $15 copay and no coinsurance, while podiatry services and mental health or psychiatric sessions are not covered.
Preventive Services See details
Preventive services are partially covered by PriorityMedicare Thrive Plus (PPO) with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and a fitness benefit. However, sub-services such as PERS, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by PriorityMedicare Thrive Plus (PPO), featuring one routine hearing exam per year and unlimited fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered annually with no coinsurance and a copay ranging from $295.00 to $1,495.00, while OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
PriorityMedicare Thrive Plus (PPO) covers annual routine and retinal imaging eye exams with a $40 copay, no coinsurance, and no deductible. Eyewear is covered with no copay, no coinsurance, and no deductible up to a combined annual maximum of $100 for contacts, frames, and lenses.
Dental Services See details
Dental Services are partially covered by PriorityMedicare Thrive Plus (PPO) with up to a $2,500 annual maximum benefit, offering no copay and no coinsurance for most preventive, restorative, and surgical care. While Medicare-covered dental services have a $0 to $350 copay (no coinsurance) and endodontics require a 50% coinsurance (no copay), other diagnostic services, other preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
PriorityMedicare Thrive Plus (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
PriorityMedicare Thrive Plus (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
PriorityMedicare Thrive Plus (PPO) covers medical equipment with no copays, requiring a 20% coinsurance for durable medical equipment and medical supplies, and 0% to 20% coinsurance for prosthetics. Diabetic equipment is partially covered with no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by PriorityMedicare Thrive Plus (PPO) with no coinsurance, though prior authorization is required. Some diagnostic services are covered with no copay, but diagnostic procedures, tests, and lab services are not covered. Covered radiological services feature no coinsurance, with no copay for outpatient X-rays, a minimum $140 copay for diagnostic radiological services, and a minimum $30 copay for therapeutic radiological services.
Home Health Services See details
PriorityMedicare Thrive Plus (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by PriorityMedicare Thrive Plus (PPO) with no coinsurance, but while some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
PriorityMedicare Thrive Plus (PPO) covers skilled nursing facility (SNF) care with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Other Services are partially covered by PriorityMedicare Thrive Plus (PPO), excluding meal benefits. Covered services include acupuncture with a $20 copay and no coinsurance (limited to 6 treatments per year), OTC items and annual wellness visits with no copay and no coinsurance, ambulance stabilization with a $240 copay and no coinsurance, and personalized health risk screenings with a $75 copay and no coinsurance.
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